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Lack of access to oral health care is a growing problem for low income children in the United States. One proposed solution to this problem is utilizing dental hygienists to the full extent of their education and training. In 2003, Kansas altered the dental hygiene scope of practice and supervision regulations through the creation of the extended care permit (ECP) dental hygienist. In 2008, a school-based oral health intervention, that utilized ECP dental hygienists to provide preventive oral health care and referrals, was established in a Midwestern city suburb. The purpose of this case study was to assess the quality of oral health care provided by ECP dental hygienists. The central hypothesis of this investigation was ECP dental hygienists provide quality oral health care that improves the oral health of underserved children in a school-based setting. Using a case-study design, electronic medical records of children (n=986) who participated in the intervention were mined for data. Numerators and denominators from the Dental Quality Alliance Concept Set provided the framework for measurement. Patient-oriented outcomes were examined in a multi-encounter cohort (n=295) using MANOVA and Kruskal Wallace. Results revealed 26.3% of the children eligible to participate in the intervention chose to do so. On average 96.6% of the children were provided a minimum of one topical fluoride application and 34.0% had at least one sealant placed. Nearly half (48.7%) of the program participants had two or more topical fluoride applications. On average 52.8% of the children had sealants placed. The number of encounters with ECP dental hygienists had a statistically significant effect on changes in decay (p=0.014), changes in restorations (p=0.002) and changes in treatment urgency (p=0.022). A statistically significant effect of the number of fluoride applications on changes in restorations (p.0.031) was also present. These results suggests ECP dental hygienists can provide access to and the provision of timely and appropriate quality oral health care for low income children in a school-based setting and oral health care provided by ECP dental hygienists can improve the oral health status of low income children who lack access to oral health care.